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Rubella vaccination in India: identifying broad consequences of vaccine introduction and key knowledge gaps

Author(s): Winter, A.K.; Pramanik, S.; Lessler, J.; Ferrari, M.; Grenfell, Bryan T.; et al

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Abstract: Rubella virus infection typically presents as a mild illness in children; however, infection during pregnancy may cause the birth of an infant with congenital rubella syndrome (CRS). As of February 2017, India began introducing rubella-containing vaccine (RCV) into the public-sector childhood vaccination programme. Low-level RCV coverage among children over several years can result in an increase in CRS incidence by increasing the average age of infection without sufficiently reducing rubella incidence. We evaluated the impact of RCV introduction on CRS incidence across India’s heterogeneous demographic and epidemiological contexts. We used a deterministic age-structured model that reflects Indian states’ rural and urban area-specific demography and vaccination coverage levels to simulate rubella dynamics and estimate CRS incidence with and without RCV introduction to the public sector. Our analysis suggests that current low-level private-sector vaccination has already slightly increased the burden of CRS in India. We additionally found that the effect of public-sector RCV introduction depends on the basic reproductive number, R0, of rubella. If R0 is five, a value empirically estimated from an array of settings, CRS incidence post-RCV introduction will likely decrease. However, if R0 is seven or nine, some states may experience short-term or annual increases in CRS, even if a long-term total reduction in cases (30 years) is expected. Investment in population-based serological surveys and India’s fever/rash surveillance system will be key to monitoring the success of the vaccination programme.
Publication Date: Jan-2018
Electronic Publication Date: 4-Dec-2017
Citation: Winter, A.K., Pramanik, S., Lessler, J., Ferrari, M., Grenfell, B.T., Metcalf, C.J.E. (2018). Rubella vaccination in India: identifying broad consequences of vaccine introduction and key knowledge gaps. Epidemiology and Infection, 146 (01), 65 - 77. doi:10.1017/S0950268817002527
DOI: doi:10.1017/S0950268817002527
ISSN: 0950-2688
EISSN: 1469-4409
Pages: 65 - 77
Type of Material: Journal Article
Journal/Proceeding Title: Epidemiology and Infection
Version: Final published version. This is an open access article.

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